]]>https://therathink.com/bill-2-hours-of-therapy/feed/0How to Bill 90 Minute Therapy Sessionshttps://therathink.com/bill-90-minute-therapy/
https://therathink.com/bill-90-minute-therapy/#respondTue, 05 Mar 2019 18:51:57 +0000https://therathink.com/?p=2161Have you wondered how to bill out therapy sessions that are over a typical 60 minute session? This short article will teach you how. While it may seem like the obvious thing to do, adding more units to your billing is not how to bill extended sessions. Rather what is required is an add-on code […]

]]>As of February 2019, because of ACA regulations, our ClearingHouse provider OfficeAlly has instituted mandatory claims processing fees for each unique tax ID + rendering NPI combination of claims filed through their clearinghouse.

All providers will be subject to a $35 / month / unique tax ID + rendering NPI fee for each month that claims are submitted through TheraThink.

If the administrative fee for processing claims is less than 5% of your total invoice, we will not charge you this claims processing fee.

The following message is directly copied from OfficeAlly’s new claims filing agreement:

Per the Medical Loss Ratio (MLR) required by the Affordable Care Act, insurance companies are required to spend no more than 15-20% of premium dollars on administrative costs. We continue to see an increase in reimbursement cuts by Payers/Trading Partners. This reduction in rebates and the increased cost of keeping up with government rules and regulations has made it necessary for Office Ally to make adjustments to the Non-Par processing fee in order to continue to provide quality clearinghouse services to our valued customers.

Effective February 1, 2019 the Non-Par processing fee shall be calculated and charged PER UNIQUE TAX ID + RENDERING NPI COMBINATION on the claims (if no Rendering NPI is present, the Billing NPI will be used).

]]>https://therathink.com/new-aca-requirements-cause-monthly-claims-filing-fee-for-officeally-providers/feed/0How to Back Bill Mental Health Insurance Claimshttps://therathink.com/back-bill-mental-health-claims/
https://therathink.com/back-bill-mental-health-claims/#respondFri, 19 Oct 2018 00:09:24 +0000https://therathink.com/?p=2080This short article will teach you how to back bill mental health insurance claims. If your claims are old but you still want to see if they will pay out, this guide is for you. Many providers come to us asking how to back bill mental health insurance claims and unfortunately, this is a tough […]

]]>https://therathink.com/back-bill-mental-health-claims/feed/0How to Bill Blue Shield MHSA Magellan and Blue Shield of CA for Mental Health Claimshttps://therathink.com/bill-blue-shield-mhsa/
https://therathink.com/bill-blue-shield-mhsa/#respondTue, 16 Oct 2018 19:34:28 +0000https://therathink.com/?p=2058Quickly learn how to bill Blue Shield of California MHSA mental health claims, how to find out if the client has a Blue Shield of CA plan or a Blue Shield MHSA plan, and where to bill each one, along with phone numbers to dial. Blue Shield of California, a different company than Anthem Blue […]

]]>Quickly learn how to bill Blue Shield of California MHSA mental health claims, how to find out if the client has a Blue Shield of CA plan or a Blue Shield MHSA plan, and where to bill each one, along with phone numbers to dial.

Blue Shield of California, a different company than Anthem Blue Cross of California, handles most of their mental health insurance claims by subcontracting them out (a carve out) to Magellan. How to bill Blue Shield MHSA becomes a problem when the client’s coverage is not handled directly by the parent company, Blue Shield of CA.

Blue Shield’s mental health department is called Blue Shield MHSA which stands for Blue Shield Mental Health Services Administrator. This change to a carve out policy was put in place on January 1st of 2012.

Blue Shield MHSA is actually just Magellan Heath Services, or Magellan. They are the business that handles Blue Shield of CA’s mental health claims. If you are in-network with Magellan, you are in-network with Blue Shield MHSA.

If you are a Blue Shield of CA credentialed provider, you might not be a Blue Shield MHSA provider. Call (877) 263-9952 to inquire about your network status with MHSA.

How to Bill Blue Shield MHSA and Blue Shield of CA

The first thing you’ll need to do is to find out which insurance company handles the client’s coverage: Blue Shield of CA or Blue Shield MHSA.

Follow our eligibility and benefits verification script to ask the right questions and confirm you are in-network with the client’s plan. Get out of network benefits quoted if you are out of network and obtain authorization if required.

Some client’s do have Blue Shield of CA and not MHSA, oddly. Blue Shield of CA covers EAP sessions, a federal plan, or out of state coverage. There are a few other cases where we are to bill to Blue Shield of CA directly.

Call Blue Shield of CA at 800 541 6652 and inquire about the member’s eligibility and benefits. During this call you will also collect where to send the claims (Blue Shield of CA vs MHSA).

Blue Shield of CA:

This is a Nightmare!

We can help you sort out these sorts of things without your input whatsoever. Our expertise comes in handy daily when parsing out these carve out policies (in all states). Learn how we can handle your mental health billing today.

]]>https://therathink.com/bill-blue-shield-mhsa/feed/0Same Day Modifiers for Mental Health Billinghttps://therathink.com/same-day-insurance-billing-guide-for-therapists/
https://therathink.com/same-day-insurance-billing-guide-for-therapists/#respondSat, 15 Sep 2018 23:46:17 +0000https://therathink.com/?p=1995This guide will teach you how to bill for multiple mental health services on the same date of service using the correct same day modifier. Mental health providers regularly perform an intake session and then see the client with their family, in group, or for another session on the same day. These claims are often […]

]]>https://therathink.com/same-day-insurance-billing-guide-for-therapists/feed/0How to Use Google and TheraThink to Find Answers to Your Mental Health Billing Questionshttps://therathink.com/google-and-therathink-fixes-your-billling/
https://therathink.com/google-and-therathink-fixes-your-billling/#respondSat, 15 Sep 2018 20:47:29 +0000https://therathink.com/?p=1984A short and sweet article teaching you how to use Google.com to search for article content answering your mental health insurance billing questions. By using Google.com and your favorite web browser, you’ll be able to quickly find out answers to common mental health billing questions. We have written tons of posts, have hundreds of interviews, […]

]]>A short and sweet article teaching you how to use Google.com to search for article content answering your mental health insurance billing questions.

By using Google.com and your favorite web browser, you’ll be able to quickly find out answers to common mental health billing questions. We have written tons of posts, have hundreds of interviews, and have dedicated so many hours to providing everyone as much free content and answers as we possible can.

And google is awesome at finding it out for you!

Simply type into the google search bar the word “therathink” followed by any question you have!

]]>https://therathink.com/google-and-therathink-fixes-your-billling/feed/0How to Understand the Allowed Amount on Mental Health EOBshttps://therathink.com/allowed-amount-billing-definition/
https://therathink.com/allowed-amount-billing-definition/#respondSat, 15 Sep 2018 20:19:46 +0000https://therathink.com/?p=1973This short article will explain what the allowed amount, or contracted rate, means on your mental health EOBs. Like every industry, the insurance claims industry has developed a fair number of new terms and its own jargon. Allowed amount, contracted rate, disallowed amount, deductible, coinsurance, par and non participating providers, PPOs and HMOs and Open Access. […]

]]>This short article will explain what the allowed amount, or contracted rate, means on your mental health EOBs.

Like every industry, the insurance claims industry has developed a fair number of new terms and its own jargon. Allowed amount, contracted rate, disallowed amount, deductible, coinsurance, par and non participating providers, PPOs and HMOs and Open Access. If you went to school to become a therapist, it’s sort of insane that you have to spend all your time learning what all of these terms means, just to do your job.

What Does the Allowed Amount Mean?

On any explanation of benefits (EOB from an insurance company, the allowed amount, also called the contracted rate by some insurance companies if you are in-network, will be listed per appointment / service code billed.

The allowed amount is what the insurance company deems you are eligible to receive in the form of payment from the insurance company and the client, combined, for that claim.

Every claim has an allowed amount listed.

It is important to note that your allowed amount is not your full fee. We regularly correct therapists about this fact: when you are submitting a claim to an insurance company, they are almost always going to negotiate your full fee down in some way. This reduction of your full fee for the client is called a EOB claim adjustment. You are not eligible to collect this amount from the client. Doing so is insurance fraud.

What Is the EOB Formula to Understand Who is Paying For What?

Your Full Fee – Claim Adjustment = The Allowed Amount (also called the Contracted Rate — they are exactly the same)

The Allowed Amount = The Reimbursement From The Insurance Company + The Patient’s Responsibility For Payment.

Allowed Amount Example Scenarios on Mental Health EOBs

Scenario 1

You bill $150 over to Cigna.

They adjust your claim by $70. This is the amount you are not allowed to collect from anyone. Please do not do so! That is insurance fraud.

The allowed amount amount is therefore ($150 – $70) = $80.

The client has a $20 copayment for each individual 60 minute therapy session. They pay $20.

Therefore, the amount the insurance reimburses is $60.

$20 Copay + $60 Insurance Reimbursement = $80 Allowed Amount.

Scenario 2

You bill $150 over to Cigna.

The client has a high deductible plan. Cigna doesn’t adjust the claim down at all. Therefore the client pays $150 out of pocket directly to the provider. This $150 is also applied against the client’s deductible, and as each claim is adjudicated for payment, the amount remaining on their deductible decreases.

So, your full fee is $150.

The allowed amount is $150.

The patient responsibility, as a deductible payment, is $150.

You collect $150 directly from the patient.

Scenario 3

You bill $150 over to Cigna

The client’s deductible is met, and they have a 40% coinsurance.

Cigna allows $80 for this claim. $80 is the allowed amount.

Therefore, with a 40% coinsurance payment on the allowed amount, the patient responsibility is $32.

The insurance company pays $48.

Totaling the allowed amount of $80.

Scenario 4 (advanced)

You bill $150 over to Cigna.

The client’s out of pocket maximum has been met on their high deductible and 40% coinsurnace plan on this exact date of service / claim.

Cigna allows $80. The client only had $22 left on their out of pocket maximum. So they pay $22, instead of $32 (scenario above), and the insurance pays $58. Then henceforth they have no coinsurance payment.

EOBs are Hard to Explain No Matter Who You Are

You can see from these example cases that the amounts posted on EOBs, even for very similar plans, can vary dramatically. As in scenario 4, a provider may be very confused about why the client’s patient responsibility has changed, often looking at the insurance company to fault. The simple fact is that there are many different factors at play influencing each amount on EOBs and they can be extremely difficult to understand.

How Can I Always Understand EOBs?

Unfortunately, it required reading each one and tracking all of their payments, including many phone calls to their insurance plan, to understand perfectly what’s going on with each payment.

Your best bet to do it on your own is to call, use a very detailed spreadsheet, and take extensive notes for each date of service when you do a call. We track the claim number, allowed amount, patient responsibility, amount reimbursed by the insurance company, check number for that payment, and reference number for that call for each date of service we finalize. We compare that information against our most recent eligibility and benefits verification phone call and possibly do another to confirm changes.

It’s a big time commitment to track this information perfectly and our process is extensive, but required to provide the outcomes we want to provide to the folks we work with.

But hopefully you now understand, as a mental health provider, what the allowed amount on EOBs refers to and how to use it to understand the amount the client owes and what you’ll be paid by insurance.

]]>https://therathink.com/allowed-amount-billing-definition/feed/0How to Bill Mental Health Family Therapy CPT Codes 90847 & 90846https://therathink.com/billing-codes-for-family-therapy/
https://therathink.com/billing-codes-for-family-therapy/#respondMon, 10 Sep 2018 21:16:44 +0000https://therathink.com/?p=1962Here's a quick guide on how and when to bill mental health family therapy CPT codes 90847 and 90846. Unlike individual therapy sessions, using the correct code to bill mental health family therapy depends on the members of the family in session instead of the time allotted. We are going to explain each mental health […]

]]>Here's a quick guide on how and when to bill mental health family therapy CPT codes 90847 and 90846.

Unlike individual therapy sessions, using the correct code to bill mental health family therapy depends on the members of the family in session instead of the time allotted.

We are going to explain each mental health family therapy CPT code, walk through four examples, and explain how to bill each example. By the end of this article you’ll know what codes to use, when, to bill family therapy for mental health CPT codes 90847 and 90846.

90847 – Family or couples therapy, with patient present.

90837 – Individual therapy for 60 minutes.

Example Scenario:

Let’s say that Client B is the person who is specifically needing treatment. Client A and Client C are part of the reason that treatment is needed, as it’s a family matter.

Then Client A, the mother, due to her own distress, decides to enter treatment.

Let’s say these folks have 4 total sessions. Here’s what they look like:

Session 1) They all attend therapy together.

Session 2) Then the following week, the mother, Client A is seen about the child in treatment, Client B.

Session 3) Then the next day, Client B is seen individually.

Session 4) And a final week later, the mother, Client A, decides that she needs to seek out therapy as well and sees the therapist about her own treatment needs.

How do we bill all of this?

Session 1: We use CPT code 90847 for family therapy with the patient (Client B) present. We then use Client B’s information when filing the claim, including their diagnosis code.

Session 2: We use CPT code 90846 for family therapy with the patient (Client B) not present. We use Client B’s information and diagnosis code when filing out the claim form. We may want to add additional diagnoses here as we learn more about the treatment situation.

Session 3: We use CPT code 90837 here for treatment with the client, Client B. Even if this client is seeking therapy about their family issues, they are seeking individual therapy. Use Client B’s information on the claim forms too.

Session 4: We are also using CPT code 90837 for the new client, Client A, as Client A is now requesting their own treatment (about their family issue). We would use Client A’s information and diagnosis when filing this form.

Summary

Always use the person who is the primary treatment seeker on your claims forms. They are the person who is seeking treatment, even if a family member is attending therapy to their benefit (90847). So even if they are not in session, like with 90846, their information is to be used.